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J.K. 79 y/o Female Primary Diagnosis: Esophageal Adenocarcinoma…
J.K.
79 y/o
Female
Primary Diagnosis:
Esophageal Adenocarcinoma
Medications
Albuterol 5 mg/mL nebulizer q 6 hrs
Budesonide 0.5 mg nebulizer q 12 hrs (BID)
Enoxaparin 80 mg subcut q 12 hrs (BID)
Fat Emulsion 20% in fusion 300 mL @ 25 mL/hr IV q evening
Fluticasone 100 mcg nasal spray daily
-Insulin Lispro (Humalog) 0-6 units subcut q 6 hrs (QID)
Metoclopramide 10 mg IV q 6 hrs
Octreotide 10 mg IV q 6 hrs
Olanzapine zydis 2.5 mg per J tube nightly
Pantoprazole 40 mg IV q 12 hours (BID)
-TPN 70 mL/hr continuous IV
PRN Medications
Acetaminophen 500-1000 mg per J tube PRN q 6 hrs for pain, headaches
albuterol- Ipratropium 3 mL nebulizer PRN q 4 hrs for SOB
Dextrose 50% 12.5-25 g IV PRN for low blood sugar
Dextrose 10% 50 mL/hr IV continuous PRN for hypoglycemia
Olanzapine zydis 2.5 mg per J tube PRN nightly for agitation
Guaifesin- dextromethorphan 10 mL per J tube PRN q 4 hrs for cough
Abnormal Labs
Low RBC (3.12) related to blood loss in surgery
Low Hgb (9.5) and Hct (29.2) related to blood loss and malnutrition
Low lymphocytes related to infection and malnutrition
Elevated CO2 related to respiratory infection/hypoventilation
Elevated blood glucose levels related to TPN administration
Low albumin related to malnutrition
Elevated BUN related to dehydration
Diagnostic Tests
XR Abdomen (1 view); verify J tube placement
Continue to monitor electrolyte levels for nutritional deficiencies
Asses for signs and symptoms of anemia ; fatigue weakness, pallor, headache
Consult a dietician
Psycho/Social
Lives in Spokane, WA
Widowed
Retired nurse
Daughter and son at bedside daily
Daughter came up from Texas to help take care of her while in the hospital
Pathophysiology
Adenocarcinoma is a type of cancer that starts in mucus-producing glandular cells of your body. Your glands make fluids that your body needs to stay moist and work well. You get adenocarcinoma when cells in the glands that line your organs grow out of control. They may spread to other places and harm healthy tissue. Adenocarcinoma usually starts in mucus glands that line the lower part of your esophagus. Treatment usually consists of chemotherapy, radiation, specific therapy and surgery.
Medical History
GERD
hiatal hernia
hyperlipidemia
kidney stones
Surgical History
EGD (7/11/19)
hysterectomy
tonsillectomy
Incontinence surgery
colonoscopy (2014)
Secondary Diagnosis
Severe Protein Malnutrition
Lower Respiratory Infection
Weight: 79.9 kg
Height: 5 ft 11 in
BMI: 25.6
Treatment
Esophagectomy (2/22/2020)
Completed neoadjuvant chemotherapy on 9/26/19
Received antibiotic treatment for respiratory infection (completed)
Encourage IS use and deep breathing
RT provide respiratory treatments daily
PT helps with ambulation daily to help regain strength- sat in chair for an hour each day
Receiving TPN for nutrition
NPO
Indwelling catheter
NG tube on low continuous suction
Risk for aspiration
Administer PO medications per J tube
NPO
HOB elevated
NG tube on low continuous suction
Risk for falls
1 person assist when ambulating
Implement fall precautions
Risk for thrombus formation r/t immobility
Promote mobility
Prophylaxis treatment of enoxaparin
Risk for nutritional deficiencies
Receiving TPN
Monitor electrolyte levels
Consult with a dietician
Risk for infection
Risk for hypoglycemia r/t TPN use
Monitor blood glucose levels
Follow insulin protocol
MRSA Contact Precautions